Accounts mask reality of funding pressures

In its review of NHS accounts the Public Accounts Committee has warned that appearances can be deceptive and that the financial sustainability of health and social care is a serious and ongoing concern.

Despite an apparent improvement in fortunes when taken as a whole, the committee says that the annual report and accounts ‘masks the underlying deficits’ at a local level and the continued use of short term measures to reduce individual deficits, such as use of the sustainability and transformation fund and money to help with winter pressures.

Recent reports that around a fifth of hospital trusts and health boards across the UK have missed their A&E, cancer treatment, and non-emergency surgery waiting time targets, hammer home the concerns we hold about the reality of the financial pressures on trusts at local level.

The continuing uncertainties surrounding the long-term funding of social care, the funding of NHS staff pay awards and the UK’s arrangements after leaving the European Union, with issues around workforce and medical supplies, also highlight the challenges the Department for Health and Social Care continues to face.

The  Public Accounts Committee recommends that the department should write to the committee by 31 January 2019 to outline how it will address the workforce issues affecting specific specialisms and geographical regions. And, as soon as the Home Office’s immigration white paper has been published, outline how it will respond to any changes in immigration policy arising from Brexit.

It should also should set out details of its assessment of the impact of Brexit on the supply of medical equipment and, where necessary, what contingencies it has put in place and establish long term solutions for winter through the integration of health and social care. This should be achieved by the time of its government’s costed 10-year social care plan, due in April 2019.

Meg Hillier, chair of the committee, said: “As Christmas approaches amid news of overcrowded hospitals, patients experiencing the worry of waiting for important treatment or surgery will take little comfort from bottom-line figures for national health spending. Missed targets, widespread deficits and the raiding of funds earmarked for other purposes tell their own story.

“It is concerning that more than a third of CCGs reported an overspend last year. This is clearly unsustainable and something we will examine in more detail in the new year. The Department of Health and Social Care must show far more urgency in getting to grips with regional funding imbalances and demonstrate it understands the effects these have at the frontline.

“But there are other indicators of an under-pressure department at risk of losing its way. The Department’s lack of clear Brexit planning could threaten the supply of medical equipment. Staff shortages could deepen. The potential consequences for patients are serious. These and other uncertainties are amplified by the continued absence of the government’s promised 10-year plan for the NHS, its promised plans for social care, and its promised plans for immigration.”